Delayed Operative Management in Complicated Acute Appendicitis-Is Avoiding Extended Resection Worth the Wait ? Results from a Global Cohort Study
Delayed Operative Management in Complicated Acute Appendicitis-Is Avoiding Extended Resection Worth the Wait ? Results from a Global Cohort Study
复制标题
DOI：
10.1007/s11605-022-05311-2
复制
发表时间：
2022-04-21
影响因子：
3.2
通讯作者：
Ricciardi, Rocco
中科院分区：
文献类型：
--
作者：
Leite, Rodrigo Moises de Almeida;de Souza, Alexandre Venancio;Ricciardi, Rocco
背景
复杂性急性阑尾炎的最佳治疗方法仍不明确。根据现行指南，采用延迟阑尾切除术进行非手术治疗的尝试可能会给患者带来更好的治疗效果，包括降低扩大切除阑尾切除术的发生率。
方法
我们对美国外科医师学会国家外科质量改进计划进行了分析，以分析血流动力学稳定的复杂性（脓肿、穿孔或两者皆有）阑尾炎患者接受早期（少于24小时）或延迟（24小时或更长时间）手术治疗的结果。
结果
延迟手术治疗与扩大切除阑尾切除术的发生率显著降低相关（风险比：2.15，95%置信区间：1.59 - 2.81，p < 0.001）。延迟手术治疗与死亡率降低的非显著趋势相关（风险比：2.17；95%置信区间：0.98 - 2.85，p = 0.05）。延迟手术治疗还与总手术时间显著缩短以及术后脓肿发生率显著降低相关。延迟干预与医疗相关的发病率之间没有关联（风险比：1.01；95%置信区间0.91 - 1.11，p = 0.811）。然而，延迟手术治疗与住院总时长显著增加相关（系数1.10；95%置信区间：1.02至1.18，p < 0.001）。
结论
延迟手术治疗可能与减少扩大切除阑尾切除术的需求、缩短手术时间以及死亡率降低的趋势相关。另一方面，它也可能与住院时间延长和短期发病率增加相关。
Background The optimal management of complicated acute appendicitis remains undefined. According to current guidelines, a trial of non-operative management with delayed appendectomy may be associated with better outcomes for patients, including a reduced rate of extended resection appendectomy. Methods We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement program to analyze the outcomes of hemodynamically stable patients presenting with complicated (abscess, perforation, or both) appendicitis submitted to early (less than 24 h) or delayed (24 h or more) operative management. Results Delayed operative management was associated with a significant reduction of the rate of extended resection appendectomy (RR: 2.15, 95% CI: 1.59 - 2.81, p < 0.001). Delayed operative management was associated with a non-significant trend towards reduced mortality (RR: 2.17; 95% CI: 0.98-2.85, p = 0.05). Delayed operative management was also associated with a significant decrease in total operative time and a significant reduction in the rate of postoperative abscess. There was no association between delayed intervention and medical related morbidity (RR: 1.01; 95% CI 0.91-1.11, p 0.811). However, delayed operative management was associated with a significant increase in total length of stay (coefficient 1.10; 95% CI: 1.02 to 1.18, p < 0.001). Conclusion Delayed operative management may be associated with a reduction in the need of extended resection appendectomy, shorter operative time, and a trend towards reduced mortality. On the other hand, it may also be associated with an increased length of in-hospital stay and short-term morbidity.